Imagine assembling an IKEA bookshelf with instructions in 12 languages, missing pages, and screws that cost vastly different amounts depending on which store you went to, unbeknownst to you. Then, after assembling it, you discover you’ll be charged even more because you used an Allen wrench.

That’s a standard experience for Americans navigating the health care ecosystem—one that feels deliberately designed to create confusion and drain bank accounts.

The numbers speak for themselves: Americans spend $4,000 more on health care every year compared to other high-income countries. Eighteen percent of adults received an unexpected medical bill over $1,000 last year. One in ten seniors have $10,000 or more in medical debt.

But these statistics don’t capture the emotional and psychological toll of committing to care without knowing how much it will cost, then getting blindsided by a bill afterward. The lack of transparency in American health care pricing cannot continue. We have a moral imperative to fix a system that punishes the people it’s meant to protect.

Systemic problems derail transparency.

Not knowing what medical procedures or services cost isn’t new. Previous attempts to make pricing clearer have fallen short. The administration recently signed an executive order promising patients more accurate pricing, but the same directive was made six years ago to no avail.

The system feels like it’s designed to benefit anyone but patients because it’s riddled with misaligned incentives that prioritize financial outcomes over quality care.

Most health systems operate under a fee-for-service payment model, which rewards volume over value. Providers are incentivized to perform procedures and services with higher profit margins over those that may be more cost-effective for patients. Plus, without price competition, hospitals can increase their margins because patients can’t shop around.

Meanwhile, health plans thrive with obscure pricing. They keep negotiated rates with providers confidential and create complex coverage rules to have leverage in provider and patient relationships. The complexity contributes to our nation’s low health insurance literacy; half of Americans don’t feel confident when using their health insurance.

These mismatched incentives create a vicious cycle: surprise medical bills stoke mistrust in the health care system. Mistrust leads to care avoidance. Avoiding care worsens conditions, and more severe conditions require more expensive emergency interventions. One survey found 41 percent of working-age adults who delayed care due to cost said their health deteriorated as a result.

These aren’t abstract problems. They create financial devastation and impossible choices for patients during their most vulnerable moments.

It’s not a lost cause: Making transparency work.

While previous attempts at reform fell short, we’re now at a critical point where technology, policy, and consumer demand are finally converging to push for real change.

Using technology to create change: Nearly every other industry has improved its consumer experience with modern technologies, and health care needs to catch up. Today’s digital tools make it possible for care teams to quickly share pricing information to help patients understand their coverage and actual costs before care. For instance, a patient can easily confirm that each physical therapy session will cost $125 out-of-pocket and can budget accordingly, avoiding the shock of unexpected bills weeks later. While not widespread yet, these solutions are improving patient experiences while helping save patients money.

Enforcement that matters: Currently, hospitals and health insurance plans face few consequences for not sharing actual care costs, so they don’t make any changes. A recent audit found that nearly half (46 percent) of hospitals aren’t following price transparency rules. For transparency to work, we need stronger enforcement, with hospitals and health plans held accountable through significant penalties for non-compliance. Existing policies have too many loopholes and must be reassessed. For example, hospitals shouldn’t be allowed to report ranges and historical rates rather than actual costs, and health insurance plans shouldn’t be allowed to adjust pricing based on factors like age without telling patients.

Shared responsibility: Progress requires change from everyone involved. Hospitals, clinics, and insurance companies need to use standardized data so pricing information is consistent and shareable. Insurance companies also need to provide clear, up-to-date cost estimates and offer payment plans so high-cost services don’t delay treatment. Care teams must discuss costs during appointments and tell patients about alternatives. Patients need to use tools that make pricing information more accessible and continue to advocate for appropriate care. Imagine being able to use an app to see how pricing for an MRI varies across local facilities, understand out-of-pocket costs, and learn from your doctor that an ultrasound would be a sufficient first step, saving you considerable money—all before scheduling an appointment.

We don’t need to dismantle the entire system to achieve price transparency; we need to rewire it so that financial success comes from quality care and experiences, not from chaos and confusion.

Ashish Mandavia is the co-founder and CEO of Sohar Health, an API-first AI platform transforming front-end revenue cycle workflows for U.S. health care providers. A former NHS doctor, Ashish transitioned from clinical practice to healthtech, bringing frontline insight into the complexity of care delivery and operations. He combines deep domain empathy with commercial acumen, having led sales and growth at fast-scaling ventures before founding Sohar. At Sohar Health, he focuses on solving eligibility and benefit verification challenges in behavioral health through strategic partnerships and seamless integrations with platforms such as Candid Health and Healthie. Now based between Dubai and London, Ashish is committed to reducing the administrative burden in health care and building high-performing, resilient teams. His professional profile is available on LinkedIn. Selected publications include work on NHS management training, interventional radiology clinics, and clinical service improvement.